Forensic AOD clients are often involved in treatment involuntarily, presenting several challenges for clinicians. These individuals are likely to have lower self-awareness of their AOD abuse problems and are more likely to challenge or disengage from treatment, compared to community populations. Motivation towards goals and treatment is increasingly recognised as an important facet in attaining change and increasing the benefit an individual will receive from therapeutic intervention (McMurran & Ward, 2004).
Motivational interviewing is a person-centred, goal-orientated style of counselling, that aims to elicit and strengthen an individual’s own motivation and commitment towards behaviour change. This is done by attending closely to the client’s language of change, exploring ambivalence and evoking their reasons for change. Whilst the practice is not designed to coerce unmotivated individuals into change, it can help individuals resolve ambivalence towards treatment and find their own motivation needed to change their behaviour.
Motivational interviewing is a respectful and collaborative practice that uses principles of acceptance and empathy to encourage clients to talk about their reasons for wanting to change. Largely, motivational interviewing aims to elicit change talk from a client, which includes any speech that favours movement in the direction of change. Speech of this nature is often subtle, so active listening is vital when identifying and evoking change talk in clients.
Clients are more committed to change when they:
- Identify the problems they face (i.e. how their behaviour conflicts with important goals or values)
- Have feelings of discomfort towards their ambivalence
- Make a shift in attitude and decide to change (e.g. acceptance of problem, openness to change, willingness to do what it takes)
- Choose a solution and ways to achieve goals
- Have adequate internal resources to support change
- Have external resources and support available to them
- Are working towards goals that are important to themselves
- Have realistic, achievable and practical goals
- Have goals within their locus of control
Key principles of motivational interviewing:
Express empathy
Acceptance and empathetic listening is key to facilitating change and minimising resistance.
(e.g. “You feel … because …”).
Develop discrepancy
A person’s likelihood to change increases when they perceive their behaviour as conflicting with their goals. Create a conversation around change, without attempting to coerce or convince the person. (e.g. “How important is it to you to make this change right now?”, “What are the benefits and costs of staying the same?”)
Avoid argument
Work alongside the client, rather than taking an oppositional viewpoint. Information should be presented in a neutral and non-judgemental way, encouraging clients to find their own motivation and reasons for change. (e.g. “Fair enough, would you be willing to talk about your goals for the future?”)
Roll with discord
It is important to respect the client’s choices and feelings, as to avoid defensive responses to treatment. Encourage the client to find their own resolutions for the goals they have decided upon. (e.g. “Where do you want to go from here”, “Ok, so you’re not wanting to quit smoking by using nicotine patches. What other options have you heard of?”)
Support self-efficacy
Believing that change is possible and within reach can help a client develop motivation towards change. Helping a client to build confidence and highlighting their strengths can help them move towards change (e.g. “It seems like you have thought this through and have got a good plan in place).
Barriers that limit change:
- Physiological drivers such as cravings/ withdrawal symptoms
- Low motivation caused by other factors (e.g., Depression)
- Disordered thinking or beliefs
- The power of habit
- Learning difficulties
- Lack of resources or help
- Low self-efficacy
It is important to identify and discuss these barriers with clients, in an open and non-judgemental manner.
Helping clients move towards change talk:
- “What would you like to see different about your current situation?”
- “What makes you think you need to change?”
- “What will happen if you don’t change?”
- “What will be different if you complete your probation/ referral to this program?”
- “What would be the good things about changing your [insert risky/ problem behaviour]?”
- “What would your life be like three years from now if you changed your [insert risky/ problem behaviour]?”
- “Why do you think others are concerned about your [insert risky/ problem behaviour]?
References:
AIPC Article Library | Principles and Techniques of Motivational Interviewing. (2018). Retrieved from https://www.aipc.net.au/articles/principles-and-techniques-of-motivational-interviewing/
McMurran, M. and Ward, T. (2004), Motivating offenders to change in therapy: An organizing framework. Legal and Criminological Psychology, 9: 295-311
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